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OCD Information & Treatment
By Wayne K. Goodman, M.D.
Obsessive-compulsive disorder (OCD) is an illness that affects thoughts and actions and is believed to be rooted in a biochemical imbalance of the brain. OCD is classified as an anxiety disorder in the Diagnostic and Statistical Manual (DSM-IV) published by the American Psychiatric Association. This puzzling illness is characterized by recurrent and disturbing thoughts (called obsessions) and/or repetitive, ritualized behaviors that the person feels driven to perform (called compulsions). Obsessions can also take the form of intrusive images or unwanted impulses. The majority of patients have both obsessions and compulsions, but a minority (about 20 percent) have obsessions alone or compulsions alone (about 10 percent). The person with OCD usually tries to actively dismiss the obsessions or neutralize them by engaging in compulsions or avoiding situations that trigger them. In most cases, compulsions serve to alleviate anxiety. However, it is not uncommon for the compulsions themselves to engender anxiety, especially when they become very demanding. A hallmark of OCD is that the person recognizes that her thoughts or behaviors are senseless or excessive. However, the drive can be so powerful that the person caves in to the compulsion even though she knows it makes no sense. One woman spent hours each evening sifting through the household trash to ensure that nothing valuable was being discarded. When asked what she was looking for, she nervously admitted, ³I have no idea, I don¶t own anything valuable.´ Some people who have had OCD for a long time may stop resisting their compulsive drives because they feel it¶s just easier to give in to them.
What Causes ObsessiveCompulsive Disorder (OCD)?
By WAYNE K. GOODMAN, MD
A condition resembling OCD has been recognized for more than 300 years. Each stage in the history of OCD has been influenced by the intellectual and scientific climate of the period. Early theories regarding the cause of a malady similar to OCD stressed the role of distorted religious experience. English writers from the 18th and late 17th centuries attributed intrusive blasphemous images to the work of Satan. Even today, some patients with obsessions of ³scrupulosity´ still wonder about demonic possession and may seek exorcism. The French 19th-century accounts of obsessions emphasized the central role of doubt and indecisiveness. In 1837, the French clinician Esquirol used the term ³folie du doute,´ or the doubting madness, to refer to this cluster of symptoms. Later French writers, including Pierre
. Behavior therapy does not concern itself with the psychological origins or meaning of obsessive-compulsive symptoms. children in harm¶s way) than why that particular individual developed OCD.. seeing a classmate have an epileptic fit).g. chalk dust).Janet in 1902. The learned fears also begin to generalize to different stimuli.. It is also incompatible with obsessive-compulsive symptoms that develop directly as the result of brain injury. such as textbooks.. but it is not grounded in evidence based on studies of the brain. stressed the loss of will and low mental energy as underlying the formation of obsessive-compulsive symptoms.. Psychoanalysis offers an elaborate metaphor for the mind. The fear of contamination with chalk dust may gradually spread to anything that can be found in a classroom. According to psychoanalytic theory. distressing and senseless forced thoughts and actions. but they do little to improve understanding of the underlying processes and have not led to reliably effective treatments. Chalk dust becomes connected with a fear of illness even though it played no causative role. the content (e. rather than reduce. Compulsions (e. moral rectitude. Learning theory does not account for all aspects of OCD. innate complex behavioral subroutines) mediated by the brain areas involved in OCD. In contrast to psychoanalysis. learning theory models of OCD have gained influence as a result of the success of behavior therapy. Because compulsions are viewed as a response to obsessions. obsessions and compulsions reflect maladaptive responses to unresolved conflicts from early stages of psychological development. The techniques of behavior therapy are built on the theory that obsessions and compulsions are the result of abnormal learned responses and actions. chalk dust) is associated with a stimulus that produces fear (e. The symptoms of OCD symbolize the patient¶s unconscious struggle for control over drives that are unacceptable at a conscious level.g. . psychoanalytic theories of OCD lost favor in the last quarter of the 20th century. Alternatively. The content of symptoms may reveal more about what is most important to or feared by an individual (e. It does not adequately explain why some compulsions persist even when they produce. Although often intuitively appealing. the effectiveness of a behavior therapy technique referred to as exposure and response prevention has been confirmed in numerous studies. Psychoanalytic concepts may help explain the content of the patient¶s obsessions.. Avoidance of the object and performance of compulsions reinforces the fear and perpetuates the vicious cycle of OCD. anxiety. Obsessions are produced when a previously neutral object (e.g. grooming and hoarding) may be related to the activation of fixed action patterns (i. These limitations notwithstanding. The psychoanalytic focus on the symbolic meaning of obsessions and compulsions has given way to an emphasis on the form of the symptoms: recurrent.e. hand washing) are formed as the individual attempts to reduce the anxiety produced by the learned fearful stimulus (in this case.g.g. The greater part of the 20th century was dominated by psychoanalytic theories of OCD. learning theory does not account for cases in which only compulsions are present.
until recently. Several other groups have since confirmed these findings. Repetitive behaviors that mimic compulsions can be produced in laboratory animals by administration of stimulants. The result is the emergence of self-protective behaviors such as grooming or checking. According to this model. it is now known that the basal ganglia function to integrate information converging from all over the brain. Other evidence for a causal role of the basal ganglia in OCD are accidents of nature. the basal ganglia have been largely ignored in theories of psychiatric illness. The immediate consequence of administering an SRI is to increase the levels of serotonin in the gap between nerve cells called the synapse. Lewis R. That a response to an SRI takes weeks to develop suggests that the delayed effects of an SRI on brain chemistry are more relevant to OCD than its acute effects. For the first time. Several of these techniques have been applied to the study of OCD with dramatic results. . These primitive behaviors. Judith L. unfold uncontrollably outside the reach of brain areas that command reason. the basal ganglia and its connections are turned on inappropriately in OCD. Dr. the basal ganglia are considered primitive structures. Baxter¶s study showed that patients with OCD had elevated brain activity in areas of the frontal lobes (particularly the orbital cortex) and the basal ganglia. Abuse of stimulants such as amphetamine and cocaine may induce repetitive behaviors that resemble the rituals of OCD. one would expect symptoms to improve after the first dose of an SRI. Once thought to be a simple relay station in the control of motor behavior. Baxter Jr.The observation that medications referred to as serotonin reuptake inhibitors (SRIs) are preferentially effective in OCD led researchers to speculate that the brain chemical serotonin might be related to the cause of OCD. if this were the only factor involved in the treatment of OCD. The basal ganglia are a group of related brain regions housed deep within the substance of the brain. advances in technology are allowing researchers to investigate the activity of the waking human brain without causing significant discomfort or risk to the subject. and colleagues of the University of California at Los Angeles and the University of Alabama in Birmingham were the first to use positron-emission tomography (PET) to study OCD. However. Because of their primitive status. PET scans produce color-coded images of the brain¶s metabolic activity.g. Rapoport of the National Institute of Mental Health has proposed an elegant neurological model of OCD that takes into account both anatomical and clinical evidence.. which are stored as preprogrammed routines in the basal ganglia. The effectiveness of SRIs in OCD furnishes important clues about serotonin. assembling and disassembling household products) during intoxication with stimulants. ³Punding´ is a Swedish slang term that describes individuals who compulsively perform meaningless activities (e. From an evolutionary standpoint. but additional research is needed to identify the precise role of this neurochemical in the treatment and cause of OCD. such as Sydenham¶s chorea and von Ecomomo¶s encephalitis that damage the basal ganglia and produce obsessive-compulsive symptoms.
checking. She also displays jerking movements of her arms. of the National Institute of Mental Health has coined the term PANDAS to refer to this variety of OCD... but a detailed interview may disclose that he /she silently counts floor tiles and hoards junk mail. It would be reasonable to pursue the possibility that an acute injury to the brain might have caused the symptoms of OCD. silent recitation of nonsense words to vanquish a horrific image). being responsible for a fire). ritualized hand washing). as we learn more about the underlying biology of OCD. germs or illness). hand washing). Common compulsions include excessive cleaning (e.g.. collecting useless items). unwanted acts of aggression (e.Examples of obsessions and compulsions Common types of obsessions include concerns with contamination (e. Most OCD sufferers have multiple types of obsession and compulsion.g. some are performed as unobservable mental rituals (e. fear of dirt.... unacceptable sexual or religious thoughts (e.g.g. repeating routine activities (e.. Someone with OCD may complain primarily of obsessive-compulsive symptoms involving asbestos contamination. Most cases of OCD begin inconspicuously and . consider a person who shows symptoms of OCD for the first time after a head injury at the age of 45. there will be genetic markers or characteristic patterns on brain scans that will confirm diagnosis. MD. How Do I Know If I Have Obsessive-Compulsive Disorder? By WAYNE K.. there is reason to believe that some cases may be precipitated by an abnormal reaction of the immune system to an untreated upper respiratory infection. counting. obtaining some medical tests may be appropriate to rule out neurological conditions that may produce obsessive-compulsive symptoms. Perhaps someday. Sue Swedo. These symptoms appear one month after having had a suspected strep throat. The diagnosis is usually based on a thorough face-to-face interview conducted by an experienced mental health professional. going in/out of a doorway) and hoarding (e. But we are not there yet. On the other hand. unwanted impulse to harm a loved one). GOODMAN. Although such onset is not typical of OCD. safety/harm (e.. Another example is a 10-year-old girl who suddenly develops concerns about germs and begins washing her hands incessantly. sacrilegious images of Christ) and the need for symmetry or exactness.g. While most compulsions are observable behaviors (e. For example. ordering and arranging rituals.g.g.g.g. MD There is no reliable diagnostic test for obsessive-compulsive disorder (OCD).
To experienced clinicians.Compulsive Disorder SYMPTOMS Obsessive-compulsive disorder is characterized by either obsessions or compulsions: Obsessions as defined by: . magazine or internet article. Although it is best to do this in person. The process of discovering OCD often starts with watching a TV talk show or news segment. the majority of individuals who are diagnosed as having OCD first make the diagnosis themselves. Other times. They didn¶t know how to describe their experience until they heard it described by someone else who gave it a name. It is only in retrospect that one looks back and recognizes some of the early signs of the illness.´ That coverage triggered a cascade of media attention on OCD that stimulated clinical and research activity and galvanized an advocacy movement ² culminating in the formation of the Obsessive Compulsive Foundation. MD. Sometimes the examples seem absurd and one can¶t imagine how anyone in her right mind could have such thoughts or engage in such ludicrous behaviors. They thought they were losing their mind until they realized they were suffering from a legitimate brain-based illness. or reading a newspaper. Individuals may call years after viewing an OCD story on Oprah or ³20/20 to ask for a consultation. like you are doing right now.gradually become more apparent over many months or years. In fact. Inc. They are products of the disease. Obsessive. Many people with OCD felt alone until they witnessed the story of someone like themselves. the questions are right on target and it feels like the checklist was written just for the individual completing it. Awareness about OCD grew following a 1987 segment on OCD broadcast by the ABC-TV network program ³20/20. It often takes people a long time to seek out help for OCD. none of the thoughts or behaviors of OCD seem odd or outlandish. Nevertheless. The symptoms of OCD can be so disagreeable and so private that they are very difficult to share with anyone. including loved ones and trained professionals. the reason given is usually embarrassment. A simple device used to reduce the shame of sharing such sensitive material is a checklist featuring examples of obsessivecompulsive behavior. They finally had hope because scientists were making progress in squelching this unwelcome ruler of their inner domain. The symptoms of OCD don¶t influence a clinicia¶s perception of the person so afflicted any more than pus from an infected wound would make a physician feel that the patient is morally decayed. some people prefer to fill out a questionnaire initially on their own. even after they learn it is a treatable illness. once called them. the ³hiccups of the brain´ as Judith Rapoport. there are some things you can do to determine if you have OCD. When asked why it took so long.
The disturbance is not due to the direct physiological effects of a substance (e.. or images are a product of his or her own mind (not imposed from without as in thought insertion) Compulsions as defined by: 1. or according to rules that must be applied rigidly 2. occupational (or academic) functioning.. or images. If untreated. If another disorder is present. ordering. are time consuming (take more than 1 hour a day).g. a medication) or a general medical condition. the content of the obsessions or compulsions is not restricted to it. Repetitive behaviors (e. repeating words silently) that the person feels driven to perform in response to an obsession. MD OCD can be relentless. however. or significantly interfere with the person's normal routine. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. only to get worse . or images that are experienced.. hand washing. counting. as intrusive and inappropriate and that cause marked anxiety or distress 2. The Course of ObsessiveCompulsive Disorder (OCD) By WAYNE K. or images are not simply excessive worries about real-life problems 3. Recurrent and persistent thoughts. The person attempts to ignore or suppress such thoughts. impulses. checking) or mental acts (e. or usual social activities or relationships.AND: --At some point during the course of the disorder. at some time during the disturbance. these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive --. That is. GOODMAN. impulses. a drug of abuse.g. or to neutralize them with some other thought or action 4. impulses. OCD is usually chronic and follows a waxing and waning course. praying. The obsessions or compulsions cause marked distress. The person recognizes that the obsessional thoughts. The thoughts.1. symptoms may get somewhat better for months or even years. impulses.g. the adult has recognized that the obsessions or compulsions are excessive or unreasonable (not applicable to children).
GOODMAN. of which clomipramine is an early example. MD Before the late 1960s. the British psychologist Victor Meyer reported in 1966 that two cases of OCD had responded to a behavior therapy technique later referred to as exposure and response prevention. In some adult cases. it is better for most people with OCD to keep busy. have each been established as effective treatments for OCD. Traditional talk therapy based on psychoanalytic principles was rarely successful in reducing the severity of obsessions or compulsions. The most broadly effective treatment for OCD appears to be a combination of a SRI and behavior therapy. The success rate with a range of different medications was just as disappointing. several European psychiatrists reported in the late 1960s and early 1970s that a medication called clomipramine was effective in a series of cases of OCD. or what is commonly known as strep throat.again before returning to a lower level of severity. exposure and response prevention has undergone considerable refinement by several noted behavior therapists. recent research suggests that some cases of OCD in childhood may be preceded by an upper respiratory infection with Group A Beta-hemolytic streptococcus. a condition called postpartum OCD. Presumably. Second. Two developments mark the beginning of the modern era in the treatment for OCD. the onset of OCD is not associated with an external event. Since it was first introduced for OCD. In fact. Understanding and working through the symbolic meaning of obsessions may have enhanced a patient¶s understanding of the workings of his/her mind. OCD was generally considered unresponsive to a range of conventional therapies. Women with OCD often report that their symptoms become more severe the week before their menstrual period. First. behavior therapy and serotonin reuptake inhibitors (SRIs). including the English psychiatrist . On the other hand. this is related to the natural ebb and flow of hormones that regulate the menstrual cycle. In a number of subsequent studies conducted around the globe. Idleness can be the breeding ground for increased obsessional thinking. MD. Stress can make OCD worse. of the National Institute of Mental Health. Diet has not been shown to influence OCD. Sue Swedo. This exciting new avenue of research will undoubtedly be the subject of intense investigation in the coming few years. In the majority of cases. or PANDAS. Treatments for Obsessivecompulsive Disorder By WAYNE K. OCD first appears in women after childbirth. Another 5 to 10 percent experience progressive deterioration in their symptoms. has coined the term Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep. but it proved insufficient in turning the tide of obsessive-compulsive behavior. but trying to eliminate all stress is unlikely to quell OCD. Behavior therapy attempts to modify maladaptive behaviors by employing strategies that focus on the present. to refer to this syndrome. Changes in the severity of OCD may be related to fluctuations in the body¶s internal chemical environment. Only about 5 to 10 percent of OCD sufferers enjoy a spontaneous remission in which all symptoms of OCD go away for good.
but are unable to stop themselves. Obsessive. Unfortunately. and by the psychologist Edna Foa. or who are nearly convinced that their fears are valid. though many therapies work by helping the individual learn that no catastrophe occurs when the behaviors do cease. response prevention consists of instruction to abstain from compulsive rituals. Common forms of this are checking locks. Afflicted individuals usually experience severe anxiety if unable to complete their rituals. obsessions alone. Interest in OCD has exploded and we seem to learn more about it every day. The aim is simple enough: to teach patients with OCD that they can master anxiety provoked by obsessions without performing rituals. or recurrent intrusive thoughts of hurting oneself or one's children.Isaac Marks. Furthermore. The successful application of these techniques requires the skills of an expert therapist and the full commitment of the patient. and lights. There is reason to be optimistic about the future. Exposure consists of confronting the patient with situations that evoke obsessional distress. behavior therapy may not be suited for everyone.Compulsive Disorder Treatment y y y y Introduction Psychotherapy Medications Summary Introduction Obsessive-Compulsive Disorder is one of the most difficult to understand of all psychiatric illnesses. Persons who have this condition find themselves repeating certain behaviors or thoughts again and again and again and again. seem to do less well with behavior therapy alone. Many times relatives become angry and upset when they are forced to deal with the time-consuming and unrealistic repetitive . now at the University of Pennsylvania. OCD patients with depression. Research has shown that one of the most difficult problems in OCD is in getting family members to understand that the patient is unable to simply stop the behavior. This underscores the need for ongoing research into the causes of OCD so that new and better treatments can be developed. At least 10 to 20 hours of treatment and practice are required to achieve a favorable outcome. they learn through repeated exposure that the obsessions will eventually disappear. Despite recent advances in behavior and medication treatment. They know the repetition is unnecessary. The first step is to recognize that you or your loved one may have OCD and that help may be just around the corner. Success rates as high as 80 percent have been documented. not everyone responds to treatment for OCD. stoves. However. about one-third of people with OCD fail to experience improvement. sometimes supervised by significant others or clinical staff.
and instead complain only of anxiety or depression. Systematic desensitization techniques involve gradually exposing the client to ever-increasing anxiety-provoking stimuli. the client is directed to do nothing but think of one obsessional thought which they have complained about.. OCD was seen as a purely psychological disorder. Exposing a patient to either of these techniques without increased coping skills can result in relapse and possible harm to the client. especially those with specific small steps geared to the exact obsessions. Through thought-stopping. before attempting something like systematic desensitization or flooding. the individual learns how to halt obsessive thoughts through proper identification of the obsessional thoughts. and then averting it by doing an opposite. Flooding's potential harm usually outweighs its potential benefits (e. and then encouraged to transplant this behavior to the privacy of their home. the obsession can lose some of its strength. With this background. Relaxation techniques may include imagery. though.behaviors. flooding is not recommended except in rare uses. Systematic desensitization is the preferred technique of the two. Two common and popular techniques are systematic desensitization and flooding. A common incompatible response to an obsessive thought is simply by yelling the word "Stop!" loudly. Flooding allows the patient to face the most anxiety-provoking situation. 10-15 minutes at a time) over a number of days (3-5 days). however. Behavior therapy has a lot to offer individuals with this disorder. The client can be encouraged to practice this in therapy (with the clinician's help and modeling. traumatizing the individual further). for example. and muscle relaxation. Medications . It is important to note here.g. that such a technique should not be attempted until the client has successfully learned relaxation skills and can demonstrate their use to the therapist.g. breathing skills. The latter technique would be more effective in public. Psychotherapy For many years.compulsions involved in the individual case. Through saturation.. Insight oriented psychotherapy has been singularly unsuccessful in treating this group of disorders. if necessary). Additional behavior and cognitive-behavioral techniques which may have some effectiveness for people who suffer from this disorder include saturation and thought-stopping. it is no wonder that many patients do not volunteer their symptoms. such as tweaking a rubber-band which is around their wrist whenever they have a thought. while using the relaxation skills learned. After a period of time of concentration on this one thought (e. Behavior therapies have had much more success. incompatible response. It is important for the client to find a relaxation technique which works best for them. related to a desire to control one's environment or to undo some perceived wrong action. They can also often use other incompatible stimuli.
With medications. generally the dose used to treat depression is not enough to control OCD symptoms. medications have been found to be fairly successful in the treatment of OCD. Impotence and delayed or failed orgasm occurs with clomipramine. Therefore treatment with antibiotics early in an infectious illness may reduce the chances of future obsessive thinking. a neurotransmitter. as do many people with OCD. Most treatment can be expected to reduce symptoms by 50-80% or more. This then is one of the few areas in all of mental health where clear proof exists for the efficacy of multiple types of treatment. Like other tricyclic antidepressants. The area of the brain that functions abnormally is directly next to those areas that relate to tick disorders such as Tourette's Syndrome and to Attention Deficit Disorder. or may be overlapping. Safety concerns with clomipramine include adverse affects on heart conduction and .In the last 25 years. Clomipramine is the most thoroughly studied drug for OCD and was the first to receive FDA approval for this indication. and worsens when the individual is under stress. Summary Imaging studies have also demonstrated that both medications and behavior therapy alter brain metabolism in the direction of normalcy. Patients often will take 2-4 times the usual amount. nausea and tremor are also common with clomipramine. was effective in treating OCD. however. Many people with ADD also have tics. The illness is cyclic. Medications for Obsessivecompulsive Disorder By WAYNE K. In the last few years. This has been followed by several of the newer SSRI class anti-depressants that act selectively on the re-uptake of serotonin. Virtually no treatment is curative for OCD. Behavioral therapy with medications seems to offer the best long term improvement. It now seems that variable amounts of dysfunction produce clinical symptoms that may be virtually all in one of these areas. First was the tricyclic antidepressant clomipramine (Anafranil). neuro-imaging studies have begun to disclose the underlying pathophysiology of OCD. Like other SRIs. constipation and urinary retention are common. not other tricyclic antidepressants such as imipramine (Tofranil). Most unexpected is the finding that children who have Rheumatic Fever and develop Sydinham's Chorea have a significantly increased risk of OCD. GOODMAN. Many patients complain of fatigue and weight gain. MD The modern era in the pharmacotherapy of obsessive-compulsive disorder (OCD) began in the late 1960s with the observation that clomipramine. side effects of dry mouth.
Clomipramine (Anafranil) has a number of different chemical properties. The effectiveness of fluvoxamine has been confirmed in children. most neurons are separated from each other by a narrow fluid-filled gap called the synapse. In addition to clomipramine. including the ability to latch on to the serotonin reuptake pump and prevent the movement of serotonin into its home neuron. Medications such as clomipramine which block the serotonin pump are referred to as serotonin reuptake inhibitors or SRIs. an electrical signal is triggered and passes along the receiving neuron to convey information elsewhere in the brain. Daily treatment for eight to 12 weeks may be required before the symptoms of OCD begin to recede. The only medications that have been consistently shown effective in treating OCD are antidepressants that interact with the brain chemical serotonin.e. is an effective antidepressant but is ineffective in treating obsessivecompulsive symptoms. SRIs take time to work. With the key in the lock. The risk of seizures increases significantly at doses over 250 mg daily. tremor and sexual dysfunction (problems with orgasm). For example. released serotonin is actively taken back up into the neuron from which it was released. insomnia. The most common side effects are nausea. All potent SRIs tested to date have proven effective in treating OCD. these drugs lack significant affinity for brain receptors that are thought to be responsible for undesirable side effects. In a series of different studies. In other words. including fluvoxamine (Luvox). Selective SRIs are generally well-tolerated. the medication is usually . desipramine. Unlike clomipramine. trials have been conducted in OCD patients with a newer generation of antidepressant drugs that are both potent and selective blockers of serotonin reuptake. sertraline (Zoloft) and paroxetine (Paxil). In recent years. Serotonin is one of the brain¶s many chemical messengers or neurotransmitters that allow one nerve cell (called a neuron) to communicate with another neuron. This specificity of response lends weight to the widely held opinion that OCD might involve some type of a biochemical imbalance. the selective SRIs are ³cleaner´ drugs compared to clomipramine. Also in contrast to clomipramine (and other tricyclics). Instead of being joined directly together. Once improvement occurs. assisting in reclaiming it for later release.. Thus. There. none of these medications loses its selectivity for blocking serotonin reuptake in the body. This serotonin reuptake pump acts to recycle serotonin. a neurotransmitter is released into the synapse where it floats freely across to the adjoining neuron. Some evidence suggests the selective SRI citalopram (Celexa) may also be effective for OCD. researchers have shown that SRIs are more effective in treating OCD than other antidepressants that do not interact with the serotonin pump. paroxetine. i. The receptor is like a lock and the neurotransmitter the key. several selective SRIs have been shown effective in treating OCD. but not all antidepressants can treat OCD. There are few significant safety concerns and the risk with overdose is small. fluoxetine (Prozac). In addition to interacting with the adjoining neuron. even though it does not have FDA approval for this indication. which is not an SRI.seizures. It also may serve to reduce the amount of ³noise´ that would be generated if too much serotonin lingered in the synapse after each nerve firing. sertraline and fluoxetine. Intentional overdoses with clomipramine can be lethal. all SRIs can treat depression. drowsiness. it comes in contact with a specialized part of the neuron called the receptor. fluvoxamine. In order for an electrical signal to pass from one neuron to the next.
Dateline and Oprah. generally do not have enough life experience or self-awareness to make this critical distinction. constipation and weight gain. Nearly two-thirds of patients with OCD experience significant symptom relief on SRIs. however. It also has risks associated with it. Children. but it is rarely complete. much more common than was previously thought. Adults with OCD usually know they have a problem. including dry mouth. SRIs are not without side effects. Adding behavior therapy may reduce the rate of relapse following discontinuance of medication. It is the condition Jack Nicholson¶s character has in the movie ³As Good as it Gets. but the majority seem to relapse after complete discontinuation of medication. diarrhea. but for the most part the selective SRIs listed above are better tolerated than clomipramine. the author of Freeing Your Child from Obsessive-Compulsive Disorder and the director of the Children¶s Center for OCD and Anxiety in Philadelphia. Nausea. however. the degree of change is meaningful. directly affecting at least one person in 40 in the general population. Interestingly. According to Tamar Chansky. is how many children suffer from OCD. When they find themselves performing bizarre or repetitive rituals. in fact. A person with OCD who has had a good response to an SRI might report that the time occupied by obsessions and compulsion is cut from six to two hours a day. Clomipramine may produce additional unpleasant symptoms. They are able to separate their obsessivecompulsive thoughts and behaviors from normal. . With help from their doctor.´ It¶s been featured on television programs such as 60 Minutes. insomnia and daytime drowsiness are some of the common side effects of the SRIs. When Your Child Has ObsessiveCompulsive Disorder By AMY WILENSKY Most people have heard of OCD (obsessive-compulsive disorder). including possible adverse affects on heart rhythm. such as washing their hands over and over. healthy thoughts and behaviors. seizures and death with overdose. Chansky also reports that the condition affects at least one in 100 American children and that the average age of onset is 10.continued for at least another six to 12 months. What is really shocking. Among those that do improve. they are ashamed and feel like they are going crazy. Some patients will tolerate one SRI better than another. Marked improvement can be observed even after 35 years of continuous obsessive-compulsive symptoms. which is considered the first step on the road to recovery. most patients can find a dosage of medication that relieves symptoms while keeping side effects to a tolerable level. tremors.2. how long someone has had OCD does not predict how well they will respond to SRI treatment. This may allow the individual to return to work or school and resume a relatively normal and fulfilling life. Some patients can be successfully tapered off medication. there are more than a million children in the United States today with OCD. OCD is.
disease. The good news is that OCD. What parents can do is make their children feel safe and comfortable and watch them carefully for any of the following signs: Obsessions y y y y y y y y Contamination ² excessive concern over germs. Sexual themes ² obsessive thinking about sex. Hoarding ² stockpiling of useless or meaningless objects such as old newspapers or food. illness. Harm to self or others ² irrational fears such as causing a car crash. Symmetry ² need to have possessions or surroundings arranged symmetrically or to move in symmetrical ways.or herself or another person with a knife or other sharp object. Checking ² returning to check that the door is locked more than once. in adults as well as children. though. Symmetry ² need to have socks at same height on each leg. Doubting ² becoming convinced that he or she hasn¶t done something he or she is supposed to do.Often. brushing teeth until gums bleed. This is why it is so important that adults are aware of OCD and knowledgeable enough about it to detect it in children. performing tasks a certain number of times regardless of sense or convenience. the voice doesn¶t get shut off ² it becomes louder and more insistent instead. . death or morality. you will need to guide your child through the acceptance and recovery processes step-by-step. Numbers ² fixation on a particular number or series of numbers. But how do you know if your child has OCD? Kids often become experts at hiding their symptoms because they feel humiliated and scared. disturbing writing or doodling of a sexual nature. OCD: Recognizing the Problem What is OCD exactly? Chansky suggests we think of it as a ³brain glitch. Compulsions y y y Washing and cleaning ² washing hands until they are red and chapped. contagion.´ or ³there are harmful germs on the telephone´ ² and the affected person needs to perform rituals to shut off the voice delivering the message. stabbing him. Religiosity ² preoccupation with religious concerns such as the afterlife. these kids are too embarrassed to tell their parents or an adult what is going on.´ in which the brain sends false messages ² such as ³the stove is still on. Most people with OCD are able to retrain their brains to ignore the false messages until they just stop getting sent. etc. As a parent. Because OCD is a vicious cycle. cuffs of exactly equal width. is highly treatable.
Praying ² excessive. refusing to throw away soda cans or gum wrappers. time-consuming repetition of protective prayers or chants. What you are looking for is signs of the obsessions and compulsions and several of the manifestations in a child who appears to have a lot on his or her mind. If not. obsessions (baseball cards. . you will still glean information based on his or her reaction. Then it¶s time to get help. including slowness to complete easy work behavioral difficulties such as angry outbursts when questioned about odd rituals or desires (such as his or her need for symmetry) social difficulties or a desire to spend excessive time alone family conflict over usually mundane details. nail biting).ocfoundation. it is not abnormal to check that you¶ve locked the front door twice. such as erasing letters on a page until the paper wears through. on a stressful morning. musical groups) and compulsions (hair flipping.´ redoing a task that has already been acceptably completed. what you want is a behavior therapist who is also an expert in childhood OCD.y y y y Counting ² counting of steps while walking. many of us. engage in one or even a few of the above obsessions or compulsions. wearing a lucky T-shirt). According to Chansky. your therapist can help you make that decision. insistence on performing a task a specific number of times. Although you may eventually want to talk to a psychiatrist about SSRIs. at some point in time or consistently. For example. for instance. Hoarding ² hiding food under the bed. such as the way the table is set Obviously. contact the OC Foundation at (203) 315-2190 or at www. But if you notice your child engaged in several of these activities over a period of weeks. For a referral. You may hold onto old newspapers or magazines for what others consider an excessive period of time. Repeating/redoing ² performing a mindless task repeatedly until it ³feels right. Of course. Getting Help Talk to your child if you think you may be on to something ² he or she may well be relieved you have noticed and could be eager to tell you what¶s going on.org. many kids have superstitions (avoiding sidewalk cracks. and many of the above manifestations affect non-OCD children for an infinite number of reasons. which may indicate the presence of real obsessive-compulsive behavior and possibly full-blown OCD: y y y y y y y y y y stress sleep deprivation depression or shame agitation slowness in performing everyday tasks such as getting dressed in the morning or preparing for bed manic need to keep busy academic difficulties. medication is not always necessary to treat OCD in kids. observe him or her very carefully for signs of the following.
Remember That No One¶s at Fault You must know and believe that your child is not trying to aggravate you with obsessivecompulsive behavior. no matter how annoying it may be. or anyone¶s neurosis. and the behaviors most likely annoy your child even more than they annoy you. The best thing you can do is help your child learn to stop. understand that you are not helping your child by participating in his or her obsessive-compulsive rituals. any more than the chickenpox or the flu. whose instincts tell them to do all they can to ease their child¶s pain. And although this is especially difficult for parents. not a psychological condition. . OCD has nothing to do with your parenting skills. your neurosis. He or she can¶t help it ² OCD is a biochemical brain glitch.